CHICAGO - Despite recent attempts by emergency medicine (EM) physicians to secure a major role for their specialty in emergency department (ED) ultrasound and x-ray studies, radiologists still retain overwhelming control over the exams, according to a presentation Monday at the 2007 RSNA meeting.
"Given their low level of experience at formally interpreting ultrasound and x-ray, it seems unlikely that EM physicians can achieve the necessary competence to take responsibility for these studies in the future," said presenter Dr. David C. Levin of Thomas Jefferson University Hospital in Philadelphia.
To determine whether EM physicians had increased their role in these studies in recent years, the researchers examined the national Medicare Part B Physician/Supplier Procedure Summary Master Files for 2001 through 2005.
Using Medicare place-of-service codes, they selected all noncardiac ultrasound and all x-ray studies performed in EDs on the Medicare fee-for-service population. All global and professional component claims were tabulated, and the researchers used Medicare's physician specialty codes to identify all studies interpreted and billed by EM physicians, radiologists, and other physicians.
Noncardiac ultrasound studies increased 60% between 2001 and 2005, reaching 448,675 exams, Levin said. Of these, radiologists interpreted 393,897 (87.8%), while EM physicians only handled 4195 (0.9%).
"I have to qualify that by saying that we don't know how many times they informally looked at the ultrasound exam or practiced doing ultrasound exams, and so on and forth," Levin said. "But the fact of the matter is, if you're interested in looking at who is the physician of record, who dictates the report, and who takes the responsibility for that examination in the ER, it's less than 1% of the time (that it's the emergency physician). If you look at their 2005 volume … that is less than the output of one single ultrasound machine."
In 2001, EM physicians performed 0.3% of noncardiac ultrasound studies, while radiologists handled 91.3%. In 2005, vascular surgeons and other surgeons interpreted 17,206 (3.8%) and 14,578 (3.2%), respectively.
ED x-ray exams reached 10,029,738 in 2005, up 29% compared with 2001.
"There was a considerable increase in ED medical volume of both ultrasound and x-ray studies between 2001 and 2005," Levin said.
Of the 2005 x-ray studies, EM physicians read 236,250 (2.4%), while radiologists interpreted 9,645,136 (96.2%). In comparison, radiologists held a 96.5% share in 2001, while EM physicians handled 2.2%.
While the studies interpreted by EM physicians rose slightly during those years, their overall share remained very low, Levin said.
"Radiologists strongly predominate in both of these areas," Levin said.
By Erik L. Ridley
AuntMinnie.com staff writer
November 26, 2007
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